Intended for healthcare professionals


Why are there shortages of HRT and other drugs in the UK?

BMJ 2022; 377 doi: (Published 18 May 2022) Cite this as: BMJ 2022;377:o1183
  1. Jacqui Wise
  1. Kent, UK
  1. jacquiyoung1{at}

Shortages of HRT have again hit the headlines, highlighting wider problems associated with complex global supply chains, Jacqui Wise explains

How big is the problem of drug shortages in the UK?

Shortages of drugs are “becoming an increasingly frequent matter,” says the Pharmaceutical Services Negotiating Committee (PSNC). Over recent years there have been supply problems with medicines including antibiotics, anti-inflammatories, antidepressants, anti-epileptic drugs, anti-psychotics, statins, and oral contraceptives.1 A Chemist and Druggist survey in 2019 found shortages across all 36 categories of medicines.23 A more recent survey by the pharmacy magazine reported shortages across all 30 brands of hormone replacement therapy (HRT) between October 2019 and March 2020.4 Pharmacies have this month run out of some hay fever drugs because of an industry wide shortage of chlorphenamine maleate.5

Shortages are not confined to the UK—the latest survey from the Pharmaceutical Group of the European Union says there is a continued high incidence of drug shortages in most European countries.6

Why is the shortage of HRT products particularly prominent?

Some HRT products, particularly gels, are in short supply. The causes are “complex and multifactorial,” according to the British Menopause Society, Faculty of Sexual Reproductive Healthcare, Royal College of Obstetricians and Gynaecologists, and the Royal College of General Practitioners (RCGP).7 In a joint statement they say, “HRT supply has not always been reliable in recent years, with multiple factors including manufacturing capacity, understanding current and future demand, and disruption of global supply chains all contributing.”

The organisations also point to a “sea change in the public conversation around menopause.” Increased awareness of the menopause and HRT has been called the “Davina effect” after a Channel 4 documentary presented by Davina McCall in May 2021.

The Department of Health and Social Care (DHSC) says demand for HRT has risen 38% in the past seven years, as access has been extended. Prescriptions …

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